Cultural sensitivity and research involving sexual minorities.

45 Volume 37, Number 1, March 2005 It is only reasonable to assume that public health research studies and interventions should be considered appropriate and relevant by their participants. Such appropriateness and relevance is, moreover, a prerequisite to having participants. Yet, if this is a key to participation, why do researchers and program planners know so little about what issues determine whether sexual minorities deem given projects to be safe, appropriate and relevant? In this issue of Perspectives on Sexual and Reproductive Health (page 6), Marrazzo, Coffey and Bingham offer results of a qualitative study of young lesbian and bisexual women, reporting their thoughts and experiences about sexual practices and sexually transmitted diseases (STDs). This study is one of only a handful to collect the cultural information necessary to plan effective sexual health interventions for sexual minority populations, other than HIV prevention studies involving gay or bisexual men. Women in this study perceived themselves to be at low risk for STDs, which they considered a heterosexual issue. Not surprisingly, they did not have accurate or extensive knowledge of bacterial vaginosis or STDs. Women expressed both a desire to talk openly with their health care providers about sexual health and a reluctance to do so. STD interventions, they maintained, need to emphasize healthy sexuality and respect for one’s body and one’s partner, and to avoid negative messages regarding sexual practices or female genitalia. Such cultural knowledge is critical for sexual health research or interventions in sexual minority populations because a project that inadvertently sends the message “We don’t understand you” could alienate the very people it seeks to reach. The questions required to gain sexual health knowledge may be touchy for research participants of any sexual orientation or gender identity; however, for those who are transgender, lesbian, bisexual or gay, such questions can reach to the heart of personal identity and group affiliation. Moreover, they can evoke a history of oppression that has involved the health professions. To effectively work to improve sexual health in these communities, health professionals need to understand both the way in which sexual information historically has been guarded by individuals and misused by researchers, and the potential of culturally sensitive approaches to overcome the barriers imposed by this history.